Risk-Stratified Care Management

High-Impact Change: Risk-Stratified Care Management

Risk-stratified care management (RSCM) is the process(0 bytes) of assigning a health risk status to a patient, and using the patient’s risk status to direct and improve care. The goal of RSCM is to help patients achieve the best health and quality of life possible by preventing chronic disease, stabilizing current chronic conditions, and preventing acceleration to higher-risk categories and higher associated costs.

Identifying a patient's health risk category is the first step toward planning, developing, and implementing a personalized care plan by the care team, in collaboration with the patient. For some, the plan may address a need for more robust care coordination with other providers, intensive care management, or collaboration with community resources.

In a practice panel of 1,000 patients, there will likely be close to 200 patients (20%) who could benefit from an increased level of support. This 20% of the population accounts for 80% of the total health care spending in the United States, with the very highest medical costs concentrated in the top 1% (via the Commonwealth Fund Issue Brief, May 2011(www.commonwealthfund.org)).

Efforts to implement RSCM have the added benefit of preparing a practice to respond to payment reform. Future health care payment models will likely require practices to have a method for systematically categorizing and monitoring their patient populations, so that reimbursement adjustments can be rendered for the additional care and resources the health care team provides to high-risk patients.

Primary Advantage

Risk-Stratified Care Management with Primary Advantage

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